About 21months ago, Medical Student Leaders met in Arusha Tanzania in what is called Africa Regional Meeting for IFMSA to discuss Health Problems in Africa as a whole, stimulating themselves towards the change in Health that we required as Africans. This was under the theme Health Crisis in Africa , this was productive when it brought out the Arusha Declaration on Health Crisis in Africa, a document the Ministry of Health in Tanzania sorted after, and a document that was supposed to be forwarded to all partners interested in the Health of Africans. This is was more or less an envision of the health situation in Africa the need to take an attack approach in health as in preventive measure rather wait for the epidemics to approach then to be calling for help. Today as we celebrate the life of Osagyefo Dr Kwame Nkrumah, I re-echoe the relevance of this Declaration and need to adopt this attack approach to health, since defending an attack of Ebola outbreak or Cholera, is more risky for every health professional and his/her family. Arusha Declaration ; Power for Action 22nd December, 2012. THE ARUSHA DECLARATION ON HEALTH CRISIS IN AFRICA. INTERNATIONAL FEDERATION OF MEDICAL STUDENT ASSOCIATIONS (IFMSA) AFRICA REGIONAL MEETING (ARM) Here we present this declaration from the 8th IFMSA ARM which took place at Ngurdoto Mountain Lodge in Arusha, Tanzania, from the 18th to 22nd December, 2012. The statement aims to highlight the causes underlying the current health crisis in Africa, in hopes of continental reduction in disease burden and improved health care. The declaration identifies and analyzes the prevalent health issues across Africa and we propose that the following policy statements should be adhered to: (A) Resource Availability (1). Financial: I. Currently it has been identified that the national budgets for health are not meeting the at least 15% requirement as per the Abuja Declaration. II. Financial commitments are cornerstones in securing other resources: equipment/logistics, facilities, research, human resource training and health service delivery. III. Budget allocations should be based on the different health programmes according to disease burden. This is required to ensure transparency and equity as per the needs of the regions in question. IV. Need for a health policy to ensure mutual health insurance initiatives to reduce the high cost of health access at all levels is crucial in achieving the goal of Universal Health Care (UHC). V. Corporate social responsibility should make a contribution to the health budget. (2). Human resources: I. The “Brain Drain” has implications on each country’s economic, health and developmental status. II. Basic provisions should be present, improved upon and maintained. Introduce new incentives that will attract doctors abroad to return such as ensuring better working conditions, and better housing for healthcare workers as well as promoting lifelong training opportunities, including transnational educational conferences among professionals. III. Introducing incentives at the rural areas, motivating health workers to practice in these regions: providing housing, transport and educational facilities, in addition to the above mentioned points. IV. Improving the quantity and quality of medical education: through establishing medical schools across different regions within the country, while ensuring quality is maintained (refer to quality control). V. A recurrent question is; do we want more doctors of low quality or a limited number of graduate doctors of higher quality? We therefore propose that there should be training of more health care workers and increased investments in this initiative as an answer to the need for more health physicians whilst ensuring academic quality without compromising numbers or quality of service delivery. (3). Facilities and Service delivery: I. There is a need to build more laboratories, clinics and hospitals to match the patient needs of the region. II Equipping and maintaining the facilities: ensuring the constant availability of materials (supplies), and functioning equipment, while addressing the need to update equipment as per technological need and availability evolves. III. Ensuring that the services and technologies offered have the adequate human resources to operate and utilize them. IV. Mobile services such as mobile laboratories, as well as requisite number of health outreaches prescribed for all health institutions should be considered in policy . decisions to ameliorate as well as serve as provisional solutions to service and facility accessibility. V. For service delivery, addressing the critical issue of long waiting time, through developing priority triaging system is paramount. This also is significantly related to the lack of human and financial resources, and the current gaps in the system allowing for unnecessary delays. Addressing these issues will help lessen the waiting time. VI. Doctor-patient relations should be addressed in attempts to harness/harbour adequate interaction skills in the clinical setting. This can be achieved through organized regular trainings on ethics and communication skills. (B) Quality control 1. There is a notable gap in shared standards across institutions in Africa in education and training. 2. Establishing an accreditation system to be shared across Africa for educational and hospital institutions. 3. Streamlining medical education across Africa with focus on decreasing duration of training while increasing quality with emphasis of churning out more competent General Practitioners to curtail the deficits. 4. Placing strict rules and regulations for quality assurance of health care (services, physicians, facilities) with effective independent monitoring agencies providing regular periodic evaluations of performance. 5. Continuous training opportunities should be advanced for health professionals, and to promote multi-disciplinary trainings, as well as teamwork (including; pharmacists, policy makers, healthcare administrators, laboratory personnel). 6. Promoting evidence based practice per the Cochrane approach by increasing the availability of reference for up to date information on diagnosis and management (achieved through a widely distributed paper print monthly journal or equivalent). (C) Research 1. Through Research, evidence based medicine can be secured, and development in the field attained. This can address as well as make Research a normality in Africa, thus bridging the gap between literature arising from foreign and local sources. 2. Promoting public health research through better registries and record keeping on disease prevalence and outcomes at the clinic and hospital levels. This will ensure accurate data that will inform our policies and allow strategic adjustments in health systems thus facilitating external assistance in this research field. 3. Promoting basic science research opportunities on disease mechanisms and management with the aim of improving patient care. 4. Promoting a research culture in universities through allocating annual grants dedicated to prevalent diseases. 5. Emphasizing the students’ role as agents of change in this field through their commitments to research by introducing research departments into medical curricula as requirements for graduation. 6. Policies are needed to facilitate dissemination of research ensuring proper utilization of the work generated by creating online free access and free paper print to distribute to peripheral centers. . (D) Community Education 1. A shift towards a preventive as opposed to the curative approach is essential in enhancing community health and improved resource utilization. 2. Community initiatives: I. To educate on disease, healthy lifestyles and prevalent health misperceptions. II. To screen for prevalent diseases by region. III. To promote health services. 3. The socio-cultural effect as a determinant of health continues to exist in Africa. Community education will continue to be a public health weapon in preventive medicine. (E) Partnerships 1. A transition into Africa’s collaboration era is needed, especially among young professionals fostering exchange of ideas and experiences, introducing accessible regional conferences and promoting online forums. 2. Multidisciplinary collaborations on national and international levels: amongst nurses, physicians, students, health administrators, religious and community leaders, policy makers and health activists. 3. Corporate involvement through community based financing/micro-insurance. 4. Corporate assistance in providing a platform for advocating for health promotion. (F) Traditional medicine: 1. There is need to recognize this sector of medicine, through understanding its role as a health system in our societies, and incorporating them as key players. 2. Respecting the influence of traditional medicine and finding a middle ground for orthodox and traditional practices. 3. Exchange training: Training traditional practitioners in basic health care, enabling them to identify urgent cases in need of hospital medical care, and training health physicians in basic traditional medicine as well as promoting research into this field. 4. Registration of traditional practitioners as a way of establishing relations with the orthodox healthcare system and to incorporate their work into the health system. (G) Governance and Stewardship: 1. Ensuring strategic frameworks exist and are combined for effective oversight, coalition building, regulation, attention to system design and accountability which are all key to developing health care systems. 2. Corruption is a crucial player in the health crisis in Africa, thus: I. Introducing guidelines & protocols that ensure qualified individuals are attaining official positions. II. Transparency, easy access and accountability should be paramount themes in administration. III. Dedicated and focused efforts to identify the sources and roots of corruption through independent monitoring groups. 3. Vetting of officials through credible and well publicized application processes. 4. Creating strict and rigorous regulations for government officials seeking healthcare abroad. I. Government officials should access public hospitals within the country prior to seeking private care with the aim of building confidence in the health systems in their countries. II. The health allowance should be discontinued and a public hospital treatment fund created, which can be used by the government officials who may visit the public and private hospitals within the country. Unused health funds shall be utilized to develop the healthcare system such as increased funding for special groups. III. Those choosing to seek private or international (abroad) care must be self-funded. 5. Bridge the gap between stakeholders, policy makers, implementers, and beneficiaries by involving everyone in the policy process and ensuring continuous feedback. 6. Procurement procedures for utilities as well as detailed reports of expenditures within the health system should be provided on a regular basis to an oversight audit committee. 7. Special considerations to vulnerable groups: such as special needs people (needy children, prisoners, mentally ill people, the elderly, disabled and the like) within the health system. Conclusion: A new definition for a doctor should be promoted in our countries: a doctor is a health activist and advocate (teaching our patients how to get well and to keep well), who should have responsibilities beyond the clinic and be more involved in the community health issues. Understanding our roles in preventive medicine, we have responsibilities to human health whether its attending to sick patients or preventing sickness. Thus, more resources and efforts should be dedicated to preventive medicine. The Arusha Declaration on” Health Crisis in Africa” recognizes all other declarations that resolved to secure adequate health care as a human right and by affirmative action calls for immediate action. These include; 1. The Abuja Declaration on HIV/AIDS, TUBERCULOSIS, AND OTHER RELATED INFECTIOUS DISEASES. 24-24 APRIL, 2001. 2. The Abuja Declaration and the Plan of Action (The African Summit on Roll Back Malaria) 25th April, 2000. 3. Human Rights Charter 4. The Accra Agreements 5. The Paris Declaration 6. Libreville Declaration on Avian Influenza and the Threat of a Human Pandemic in Africa, 22 March 2006 7. The Seychelles Declaration - Meeting of the Ministers of Health of the Small Island Developing States in the African Region Seychelles, 24th of October 2006 8. The Addis Ababa Declaration on Community Health in the African Region, Addis Ababa 20-22 November 2006 9. Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving Better Health for Africa in the New Millennium, Ouagadougou,Burkina Faso, 28 to 30 April 2008 10. The Algiers Declaration Ministerial Conference on Research for Health in the African Region Algiers, 23-26 June 2008 11. Libreville Declaration on Health and Environment in Africa Libreville, 29 August 2008 12. Cape Verde Declaration Meeting of Ministers of Health of Small Island Developing States of the African Region Praia, 19 March 2009 13. The Brazzaville Declaration on Noncommunicable Diseases Prevention and Control in the WHO African Region 14. Final Communique Third meeting of Ministers of Health of Small Island Developing States of the WHO African Region, Moroni, Comores, 10 March 2011 15. The Tunis Declaration on Value for Money, Sustainability and Accountability in the Health Sector . 2012 16. The Five-Star Physician
Posted on: Mon, 22 Sep 2014 15:38:19 +0000
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